PNS Flashcards
High Radial nerve palsy usually caused by
direct pressure of the nerve as a result of
1. humeral fracture 2. elbow dislocation 3. prolonged compression “Saturday night palsy”
High Radial palsy Symptoms are
- unable to extend Wrist MCP joints
2 extend or radial abduct thumb - decreased sensation dorsum forearm + hand (wristdrop deformity )
Would a person with high radial palsy be able to extend elbow?
usually because triceps are usually spared
(supinator + brachioradialis are paralyzed) Elbow flexion and supination are possible because musculocutaneous nerve innervate the bicep
Would a person with high radial palsy be able to flex the elbow? Supinate?
yes both are possible because musculocutaneous nerve innervates the bicep.
(supinator + brachioradialis are paralyzed)
What are nerve injuries that cause motor impairments?
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What are nerve injuries that cause sensory impairments?
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Posterior Interosseous Nerve Syndrome is an injury to what nerve?
to radial nerve around the arcade of
Frohse/supinator causing motor problems in wrist and hand
Posterior Interosseous Nerve Syndrome is caused by?
- entrapment of nerve in supinator muscle 2. elbow dislocation
- Poor technique during ORIF of proximal radius FX if hardware pinches nerve 4.compression of radial nerve from
Posterior Interosseous Nerve Syndrome Symptoms
unable to extend
MCP joints
extend or radial abduct thumb
able to extend wrist but is radial deviated
Is Posterior Interosseous Nerve Syndrome motor or sensory
purely motor pain may be present but it is not primary symptom no sensory
Radial Tunnel Syndrome causes
compression/irritation of radial nerve proximal forearm at edge of supinator causing pain in the anterolateral proximal forearm
1. inflammation from repetitive forceful supination pronation of forearm and wrist flexion extension 2. direct blow to the area
Radial Tunnel Syndrome Symptoms
Tenderness achiness and pain on the outside of the elbow about 2 inches distal to the lateral epicondyle.
Radial Tunnel Syndrome what increases pain
- wrist extension
- active supination
- pronation
- holding something with the staight elbow
Does Radial Tunnel Syndrome cause muscle weakness
Primarily pain syndrome can cause weakness in wrist extensors making it difficult to steady wrist during grasping and lifting.
Does Radial Tunnel Syndrome cause sensory changes
No sensory changes usually because sensory portion of radio nerve branches off the elbow often misdiagnosed for lateral epicondylitis
How may radial tunnel syndrome and lateral epicondyleitis be clinically distinguished from each other?
pain from radial tunnel syndrome is usually more PROXIMAL FOREARM area about four fingerbreadths distal lateral condyle
pain from lateral epicondyleitis tends to originate where the TENDON that attaches to the lateral epicondyle
Why is it important to know the difference between radial tunnel syndrome and lateral epicondyleitis thinking treatment stratagies?
Common treatment for lateral epicondyleitisis use of elbow strap worn snugly around the proximal for use of the strap will make radial tunnel syndrome symptoms worse by further compressing the radial nerve
What is appropriate body mechanics training for radial tunnel syndrome
temporarily avoid task requiring
- pronation supination
- reaching with arms extended at shoulder 3. level overhead work with wrist flexed forearms pronated
Superficial Radial Nerve Syndrome (Wartenberg’s Syndrome)
strengthing as tolerated
- close direct trauma or prolonged pressure to rest area 3-4 cm proximal to wrist
- surgical pinning for distal radius fx 3. tumor/mass
- repetitive ulnar deviation and pronation causing pressure between ECRL and brachioradialis tendons
Superficial Radial Nerve Syndrome (Wartenberg’s Syndrome) Symptoms are
decreased sensation and/or tingling in the distribution of the radial sensory nerve dorsum of hand radial side
Superficial Radial Nerve Syndrome is often made worse by
extreme pronation, wrist movement, tight pinching of thumb and index can be uncomfortable at radial aspect of wrist burning pain
Superficial Radial Nerve Syndrome is often misdiagnosed for
DeQuervain’s tenosynovitis because of location of pain
How is superficial radial nerve syndrome and DeQuervain’s differentiated?
- Superficial radial nerve syndrome generally have numbness and tingling over the back of the back of hand
- DeQuervain’s are not likely to have sensory issues.
What splint is used Superficial Radial Nerve Syndrome? What do you need to watch for?
thumb spica an incorrectly applied splint will make symptoms of superficial radial nerve syndrome worse. watch tightness of stress and pressure from radial edge of wrist splint
OT intervention thumb
Pronator Syndrome is (Rare) but what is the cause?
compression of the median nerve in proximal forearm causing pain and numbness in the thumb index long fingers
(most common cause entrapment of the median nerve between the two heads of the pronator teres but there are three other sites a possible compression in this general area)
Pronator Syndrome Symptoms
Tenderness over pronator teres muscle/volar
forearm is aggravated by resisted pronation of forearm
numbness tingling thumb, index, long, and half ring finger (volar palm) generally no motor involvement
Pronator Syndrome causes impairment of which of the following
pain
motor
sensory
pain
sensory (numbness)
What is the Balentine sign?
attempts to perform tip Pinch (okay sign) thumb index the DIP joint collapse
weakness paralysis of hhhh FPL and index FDP
What is Anterior Interosseous Syndrome
rare entrapment of the motor branch of median nerve in proximal forearm
What does Anterior Interosseous Syndrome cause
pain and weakness in the thumb index and long fingers
What are the causes Anterior Interosseous Syndrome
- Trauma to elbow forearm area fractured elbow dislocation direct blow causing either direct nerve trauma secondary trauma from hemorrhages
- ORIF forearm fracture
- Entrapment ORIF forearm fracture compression from fibrous bands in forearm
Anterior Interosseous Syndrome Symptoms
- Deep aching pain in proximal forearm increases with activity,
- weakness of FPL FDP 1+2 and pronator quadratus thus positive Balentine sign and - difficulty picking small items from flat surface usually no sensory problem
Does Anterior Interosseous Syndrome impair sensory motor or pain
pain is most presenting
some motor (weakness)
usually no sensory problem
Carpal tunnel syndrome basic description is
compression of the median nerve as it passes through the carpal tunnel associated
Carpal tunnel Symptoms are
burning tingling numbness pain in palm of hand especially
thumb index and long fingers
Pain can also radiate proximately into the arm
*** grip strength thenar muscles wasting in severe and untreated cases
Is swelling visible in Carpal tunnel syndrome
no but a persons hand feel the sensation of swelling usually worse at night
Laceration to median nerve are usually due to
due to knife or glass
high-level Laceration to median nerve are usually lacerated at what site
elbow or proximal forearm leads to ape hand deformity
high-level Laceration to median nerve symptoms
- loss of thener opposition and Palmer abduction
- some IP flexion
- thenar atrophy thumb lies to the side of palm
- paralysis of FDS in the radail half of FDP with their corresponding to lumbricals causing loss of index finger MCP and PIP flexion
-pronator teres is paralyzed so pronation is difficult sensory loss in hand median nerve distribution
low-level lacerations to the median nerve are usually lacerated at what site
wrist area
low-level lacerations to the median nerve symptoms
thenar eminence flattening loss of thumb opposition and Palmer of abduction due to paralysis of the median nerve innervated intrinsics sensory loss median nerve distribution of hand
What is another name for Cubital Tunnel Syndrome? Give a brief description
“cell phone elbow” irritation of the ulnar nerve as it passes superficially of the elbow
Cause of Cubital Tunnel Syndrome.
- stretching nerve prolonged of the flexion
2. pressure on nerves resting elbow on table desk armchair
What are the Symptoms Cubital Tunnel Syndrome
- pain along the medial aspect of the elbow and tenderness over cubitul tunnel
- Numbness tingling in ring and small fingers severe cases will demonstrate intrinsic hand muscle atrophy which can lead to decreased grip strength as well as clawhand deformity due to hand weakness was so positive Fromet’s sign positive Wartenburg sign
In severe cases of Cubital Tunnel Syndrome what may happen
will demonstrate intrinsic hand muscle atrophy which can lead to decreased grip strength as well as clawhand deformity due to hand weakness
What is Fromet’s sign
tests for the action of adductor pollicis, which is weak with an ulnar nerve palsy.
A patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject’s hands. A normal individual will be able to maintain a hold on the object without difficulty. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect.
